一项质量改进计划，旨在减少连续肾脏替代治疗开始和重启延迟的频率。
A Quality Improvement Initiative to Reduce the Frequency of Delays in Initiation and Restarts of Continuous Renal Replacement Therapy.
机构信息
Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dr Cordoza); Arena Kaiser Permanente Sunnyside Medical Center, Clackamas, Oregon (Ms Rachinski); Legacy Health, Portland, Oregon (Dr Braxmeyer, Mss Nathan, Crain, and Gore and Mr Wright); and Gonzaga University, Spokane, Washington (Ms Dubuc).
出版信息
J Nurs Care Qual. 2021;36(4):308-314. doi: 10.1097/NCQ.0000000000000557.
BACKGROUND
Continuous renal replacement therapy (CRRT) is a lifesaving intervention for critically ill patients. Delays in initiation, or an inability to resume CRRT following a temporary suspension in therapy (CRRT restart), can result in suboptimal CRRT delivery.
LOCAL PROBLEM
Intensive care units across the health care system were experiencing significant delays in CRRT initiation and restarts.
APPROACH
A multimodal quality improvement initiative was implemented across 7 adult intensive care units, which allowed unit-based staff nurses to initiate and restart CRRT, a task that had previously been delegated to non-unit-based dialysis nurses.
OUTCOMES
A 75% reduction in CRRT initiation delays and a 90% reduction in CRRT restart delays were observed in the 12 months following the initiative. There were no adverse events or increased disposable CRRT circuit usage following the initiative.
CONCLUSIONS
Implementation of CRRT initiation and restarts by unit-based nurses were achievable and resulted in substantial improvements in timeliness of CRRT delivery.
背景
连续肾脏替代疗法（CRRT）是危重症患者的救命干预措施。启动延迟，或在治疗暂时暂停后无法重新开始 CRRT（CRRT 重启），可能导致 CRRT 输送效果不佳。
本地问题
整个医疗系统的重症监护病房在启动和重新启动 CRRT 方面都存在显著延迟。
方法
在 7 个成人重症监护病房实施了多模式质量改进举措，允许基于病房的护士启动和重新开始 CRRT，这一任务以前是委托给非病房基础的透析护士完成的。
结果
在该举措实施后的 12 个月内，CRRT 启动延迟减少了 75%，CRRT 重启延迟减少了 90%。在该举措实施后，没有发生不良事件或增加一次性 CRRT 回路使用。
结论
由基于病房的护士来启动和重新开始 CRRT 是可行的，并使 CRRT 输送的及时性得到了实质性的改善。
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